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Update on . . . Patient Education and Counseling
The focus of this column is to present topics of interest
from a variety of journals to Oncology Nursing Forum
readers. The topic of this issue is patient education and
counseling.
Patient Preferences
for Breaking Bad News
Breaking bad news in oncology care
is an aspect of communication that warrants critical exploration. Clinicians who
impart life-altering information need to
feel empowered, and patients receiving
the news should have the opportunity
to request a preferred mode of delivery.
Martins and Carvalho (2013) published
a study that identified patient preferences as a guide for the way in which
bad news should be received and how
those preferences can reflect personality characteristics, including patients’
health locus of control (HLC). HLC
has been associated with health-related
behaviors, particularly the patient’s
perceived control over his or her health
as internal (i.e., determined by his or her
own behavior), related to chance, or dependent on powerful others (PO). Levels
of medical information needs tend to be
lower in patients with higher scores on
the chance dimension and on PO. The
researchers hoped to use patient preference to identify specific ways in which
bad news should be imparted.
Bad news is defined as any information that is likely to alter a patient’s view
of the future. Giving bad news has a
profound impact on patients and clinicians, and clinicians who are inept in
that mode of communication have been
found to have higher distress levels.
Researchers have documented enhanced
patient satisfaction when delivery of
bad news was done at an optimal level.
Guidelines have been published to facilitate clinicians when disseminating bad
news. However, when the guidelines
were reviewed, only 56% of 245 relevant
publications provided new data, and
only 2% were intervention studies that
addressed meaningful psychosocial
patient outcomes.
© monkeybusinessimages/iStock/Thinkstock
Susan Weiss Behrend, RN, MSN, AOCN® • Associate Editor
Martins and Carvalho (2013) identified the need for consideration of
patients’ personality characteristics
and how crucial they can be on healthseeking behaviors, illness, and medical
interactions and outcomes. If physicians
do not know patients well, breaking
bad news is based on episodic, brief encounters that do not reflect the patients’
preferred delivery method. Patients’
preference have been identified and
divided into content (clinician expertise), support (emotional comfort), and
facilitation (setting).
Martins and Carvalho’s (2013) study
enrolled 72 patients with thyroid cancer
in an ambulatory oncology clinic. Patients were asked to view a video that
showed different approaches (i.e., empathetic professional, rough and ready
expert, distanced expert, and emotionally burdened expert) for breaking bad
news. Then, the patients were asked to
choose the model they preferred. The
use of a video was considered the most
ethically sound choice because of the
need to avoid interviewing patients following the actual receipt of bad news.
The study included patients who had
received a cancer diagnosis in the past,
those who were informed of the possibility of a cancer diagnosis, and those
who had been told of a negative biopsy.
The researchers believed that the inclusion of patients with varied experiences
allowed for the possibility to distinguish between patients with cancer and
healthy participants. Data were analyzed using chi-square analysis, as well
as Kruskal-Wallis and Mann-Whitney U
tests. Interviews were content-analyzed.
Fifty-six (78%) participants preferred
the empathic professional model more
than the other styles of delivering bad
news. All 72 participants expressed a
dislike for the rough and ready expert,
nine (13%) preferred the distanced
Oncology Nursing Forum • Vol. 41, No. 1, January 2014
expert, and seven (10%) preferred the
emotionally burdened expert. Preferences varied significantly with HLC
scores, presence of cancer, age, and education. Participants with higher internal
locus of control and lower PO preferred
the empathic professional model. The
article acknowledged the large body
of research that has addressed typical
ways of breaking bad news. However,
the delivery model of choice for patients
with cancer has yet to be determined.
The consideration of personality characters as determined by the HLC may
be pivotal for continuing the dialogue.
Martins, R.G., & Carvalho, I.P. (2013).
Breaking bad news: Patients’ preferences and health locus of control. Patient
Education and Counseling, 92, 67–73.
doi:10.1016./j.pec.2013.03.001
Adolescent and Young Adult
Supportive Care Needs
Adolescents and young adults (AYAs)
with cancer often are the focus of medical research related to clinical management. Documentation of social information needs of the population aged 15–39
years has been limited (Kent et al., 2013).
The Adolescent and Young Adult Health
Outcomes and Patient Experiences (AYA
HOPE) study is a population-based cohort study that examines psychosocial
and physical functioning, medical care,
and clinical trial involvement of AYAs.
AYA HOPE surveyed 523 AYA patients
6–14 months following a cancer diagnosis. Participants reported on information
needs for talking about the cancer experience with family and friends, as well as
meeting peer survivors. Factors associated with each domain were examined
using multiple logistic regressions.
Kent et al.’s (2013) article reported
on the specific findings of AYA HOPE
that were relevant to social information needs of AYA patients with cancer and survivors. Social support for
those patients is critical because the
need to establish new relationships is
recognized as one of the most pivotal
long-term challenges for AYA cancer
survivors. Alleviation of social isolation
for AYAs has the potential to enhance
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